Brown pushes to change drug legislation

WASHINGTON – Dr. Mark Piacentini, a Marion County physician, regularly turns away new patients seeking treatment for heroin addiction — even some pregnant women who are abusing the drug and want to quit.

It's not because he can't handle the additional patient load or because he can't afford to absorb the costs of treating these addicts, many of whom are uninsured. It's because federal law limits him to treating 100 patients at a time with some of the most effective opioid addiction medicines.

"Each of the last 10 weeks, I've had to turn down at least one pregnant woman who is abusing heroin because I'm so limited," Piacentini said. "They have nowhere to go," he added, noting that he's one of only two doctors in the county who treats heroin addicts with one of the federally restricted medications, called buprenorphine.

Piacentini spoke to reporters Wednesday on a conference call organized by Sen. Sherrod Brown, D-Ohio, who is pushing legislation to lift the current cap and allow other health care providers to dispense the drug.

"We've got a problem when it's easier for Americans to get heroin than it is for them to get help to break their addiction," Brown said.

Brown is co-sponsoring legislation that would allow doctors to seek a waiver of the 100-patient limit if they meet certain standards. The Expanded Opportunity for Substance Abuse Treatment Act, sponsored by Ed Markey, D-Mass., would also allow nurse practitioners and physician assistants to treat 100 patients per year with buprenorphine and other opioid addiction medications, if they complete addiction treatment training and are licensed in a state that allows them to prescribe controlled substances, among other conditions.

Brown said the bill would dramatically expand access to treatments in states like Ohio, which has been hard hit by the opioid addiction epidemic. In 2012, nearly 2,000 Ohioans died from drug overdoses, with two-thirds of those cases involving opioids, according to Brown's office.

But some experts warn that expanding access to buprenorphine could have unintended negative consequences.

"There's no question there are more people who probably would benefit from increased prescribing of this drug," said Eric Wish, director of the Center for Substance Abuse Research at the University of Maryland in College Park. "On the other hand, we have to be aware that with the increased prescribing comes the possibly of increased diversion and misuse on the street."

Buprenorphine is classified as a Schedule III narcotic, approved by the Food and Drug Administration to treat opiate dependence. It has been found to be safer than methadone.

In 2000, Congress passed the Drug Addiction Treatment Act, which made it legal for doctors to prescribe opioid addiction medications in their offices — as opposed to in a clinic setting. That law limited doctors to treating 30 patients; Congress increased that to 100 patients in 2006.

Brown and others say that restriction is outdated and is hampering efforts to stamp out the nation's opioid addiction problem.

"We have at our disposal highly effective, FDA-approved pharmacotherapies to treat opioid addiction," Dr. Stuart Gitlow, president of the American Society of Addiction Medicine, wrote in a recent letter urging support for the bill. "Unfortunately, they all come with arbitrary treatment limits that have resoundingly negative effects on treatment access and outcomes."

At the same time, buprenorphine abuse is on the rise, according to data compiled by Wish's Center for Substance Abuse Research. Abusers are injecting or snorting the crushed tablets.

"Numerous data sources indicate that buprenorphine, known on the street as Bupe, Subs, Subbies, and Orange Guys, is being diverted for use by those who do not have a prescription," a June 2011 CESAR analysis states. "Law enforcement authorities in Maine, Massachusetts, New York, and West Virginia are reporting an increase in seizures of buprenorphine together with other controlled prescription drugs."

Piacentini noted that buprenorphine is harder to abuse than other medications, such as methadone. And he said he has found it to be highly effective in helping opioid-addicted patients turn their lives around.

"They do get better. They do recover," he said. "And each person I treat affects a lot of other people in the community."

Piacentini said he's not sure how many more patients he could take on if the limits are lifted, but he said any increase would have an impact.

"I can treat more than 100 people," he said. "I need to (because) the problem is out of control."